Computer-assisted rapid movement training beneficial for fall prevention after stroke

A randomized clinical trial conducted by researchers from the Chinese University of Hong Kong (CUHK) and clinicians at Shatin Hospital and Prince of Wales Hospital in Hong Kong finds computer-assisted rapid movement training (RMT) to be as effective as conventional balance training (CBT) at improving chronic stroke survivors’ overall balance, motor function and balance recovery, indicating potential for home-based telerehabilitation.

“Falls are more common in stroke survivors than age-matched healthy older adults. To prevent falling and the severe injuries that may follow, it is vital to train stroke survivors to maintain or recover their balance,” wrote the researchers. [Stroke 2002;33:542-547; J Am Geriatr Soc 2005; 53:416-423] However, during the ongoing coronavirus disease 2019 (COVID-19) pandemic, stroke survivors have limited access to outpatient rehabilitation therapy, making telerehabilitation a more desirable option, necessitating the development of computer-assisted balance training systems.

The novel, task-specific RMT programme required 16 stroke survivors to rapidly reach out to a target with a limb following a direction cue produced on a screen. The participants were encouraged to reach as far and as fast as possible. The timing of each movement and its three-dimensional trajectory were recorded. In the CBT control group, 14 participants performed a set of balance exercises that were typically prescribed by physiotherapists from Shatin Hospital to chronic stroke survivors. Both treatments were well accepted by the participants, as demonstrated by their high motivation to attend training sessions (mean score on 6-point Likert scale, 5.4). [J Neuroeng Rehabil 2021;18:150]

“Participants in the RMT group showed improved movement completion time and larger range of motion for both paretic and nonparetic side reaching arms and stepping legs between the first, 10th, and last [ie, 20th] training sessions. For range of motion, the nonparetic arm and both legs could often reach 30 percent body height by the last training session, which was typically required to re-establish postural stability in successful change-in-support reactions in healthy adults,” reported the researchers. [Hum Mov Sci 2018;57:366-373]

Both groups showed gains in balance and motor function, as indicated by improvements in Berg balance scale (BBS, primary outcome; p=0.001 for RMT and p=0.0005 for CBT) and Fugl-Meyer assessment of motor recovery after stroke (FMA; p=0.011 and p<0.001, respectively) clinical scores. The coprimary outcome of timed up and go (TUG) test was also faster after training in both groups (p=0.011 and p<0.001, respectively). “Improvements in BBS, TUG, and FMA showed that RMT and CBT improved overall gross balance and reduced the risk of falling,” commented the researchers.

“RMT stroke participants improved their reaction time and range of motion throughout training. Our results show that RMT is as effective as CBT for rehabilitation, support introducing RMT into stroke rehabilitation, and suggest the potential for it to be applied for home-based telerehabilitation. Furthermore, the spatiotemporal measurements captured by RMT provide valuable information to clinicians for tracking patients’ progress more objectively,” they concluded.